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HomeMy WebLinkAboutBe Well Solutions DI AgreementDIETETIC INTERNSHIP AFFILIATION AGREEMENT l•\ '-~IC In tun Ii I ror 1 This Affiliation Agreement, dated this 8th day of February , 2018 , is between BE WELL SOLUTIONS DIETETIC INTERNSHIP program ("BWS DI") and Bonneville School District 93 ("Facility") located a_t_____ 3497 N Ammon Road, Idaho Falls, ID The purpose of this Affiliation Agreement ("Agreement") is to form an agreement with a Facility that is committed to providing meaningful dietetic supervised practice experiences for Interns enrolled in the BWS DI. WITNESSETH: WHEREAS, Be Well Solutions ("BWS") is currently conducting a Distance Dietetic Internship program and desires to obtain supervised practice experiences for Interns enrolled in the program; and WHEREAS, FACILITY has the facilities and capability to provide such experiences and is willing to make its facilities and personnel available for the purpose of providing supervised practice experience to Interns enrolled in the BWS DI; NOW THEREFORE, it is mutually agreed by and between Facility and BWS DI as follows: COVENANTS 1. GENERAL GUIDELINES: A. The BWS DI Director or his/her designee and the Director of the Facility shall have primary responsibility for the performance of the terms of this agreement and shall work together to ensure that the terms of this agreement are adhered to. B. Upon request, the BWS DI Director or designee shall be permitted to perform an inspection of the Facility or shadow the Intern during a scheduled rotation. C. BWS DI adheres to a strict non-discrimination policy. Neither party shall discriminate against any Intern on the basis of race, religion, gender, national origin or any other protected class set forth in Title VI I. 1 2.0. RESPONSIBILITIES OF THE PARTIES 2.1. Responsibility of BWS DI It shall be the responsibility of BWS DI to: (a) Provide an orientation week for Interns prior to the commencement of the supervised practice experiences at the facilities and, thereafter, to provide a solid foundation for Interns to successfully complete their supervised practice experiences; (b) Cooperate with Facility and assist the Interns who have elected to participate in the DI through the use of its Facilities; (c) The BWS DI Di rector or designee shall (1) act as BWS's representative to Facility; (2) facilitate communication and otherwise act as liaison with and (3) coordinate Interns' field experiences at the Facility; (d) Ensure financial responsibility of Interns by each student maintaining professional liability/malpractice commercial insurance coverage. Upon request, BWS DI shall provide evidence of such insurance for each Intern prior to approving the placement of that Intern at the Facility; (e) Require Interns to abide by applicable federal, state and local laws, standards of accrediting bodies, as well as policies and regulations of the Facility, including dress code; (f) Comply with, and require Interns to comply with all applicable federal and state laws and regulations concerning patient privacy and confidentiality of protected health information, including, without limitation, the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"); (g) Require Interns to maintain the confidentiality of all proprietary information regarding the Facility patients and clients; (h) Ensure that Interns meet health standards required by Facility and otherwise permitted under law; (i) Withdraw any Intern from the Facility who has been determined by Facility, in the exercise of its discretion, to be unacceptable for any reason described in Section 2.2 (f); and U) Maintain a record of each Intern enrolled in the BWS DI and each Intern who has completed the program for a time period of six (6) years following the completion or withdrawal from the DI ("Intern Directory Record"). Each Intern Directory Record shall include the student's name, year of certificate 2 awarded, and the most current address and phone number the Intern has provided to the BWS DI. 2.2. Responsibilities of Facility It shall be the responsibility of Facility to: (a) Provide an educationally oriented supervised practice experience for Interns; (b) Designate a contact person under this Agreement to be: ( 1) responsible for the coordination and implementation of the rotation at the Facility; and (2) a representative of the Facility to BWS DI; (c) Familiarize the intern with the Facility, its equipment, procedures, and policies and to provide Interns with copies of its rules and regulations; (d) Permit interns access to patient records for the purpose of field experience requirements, if the Facility patients provide the proper consent; advise BWS DI and the Intern of its policies and procedures concerning patient privacy and confidentiality of protected health information including, without limitation, the policies and procedures that the Facility has adopted pursuant to HIPAA; (e) Retain responsibility and accountability for all patient care and the supervision of Interns while at the Facility. Interns shall not replace the staff of the Facility; (f) Advise BWS, at the earliest possible time, of any material difficulty of an Intern to progress toward achievement of the stated objectives of the BWS DI. Notwithstanding the foregoing, Facility reserves the right to direct BWS DI to withdraw, or not to accept, any Intern whose health, conduct, or performance, as determined by Facility, in its discretion, is or may be a detriment to patients' well-being, or to the achievement of the purposes of the BWS DI or is inconsistent with its policies, procedures, or ethical requirements. (g) Evaluate the performance of the Intern, in a manner and to an extent agreed to by BWS DI and Facility, using evaluation forms provided by BWS DI. The evaluation forms shall be completed and forwarded to BWS DI following the conclusion of each lntern's participation in the supervised practice experience; and (h) Provide emergency health care for illnesses or injuries resulting from the lntern's field experience at the Facility. It shall be the responsibility of the Interns to provide payment or adequate health insurance coverage for such emergency care and any subsequent care. 3 2.3. Mutual Responsibilities of the Parties The Parties agree as follows: (a) Facility shall have the privilege of recruiting Interns for employment, provided that such employment will commence after the completion of the lntern's course of academic instruction. Upon its request, and without the objection of the Intern, BWS DI shall provide Directory Records to the Facility. (b) No Party shall have any financial obligation to any other Party resulting from or arising out of the provision of services, instruction, supervision, or facilities under this Agreement. (c) Each party shall comply with all federal, state, and local laws that are applicable to activities carried out under this Agreement. The Parties agree not to engage in unlawful discrimination on the grounds of race, color, national or ethnic origin, gender, marital status, religion, handicap, political affiliation, age, or any other basis proscribed by such laws. 3.0 RELATIONSHIP OF PARTIES 3.1 At all times under this Agreement, BWS DI and Facility shall be considered independent contractors. Nothing contained herein, nor any course of action or failure to act shall be construed to create, as between BWS DI and Facility, an employer­ employee or agent-servant relationship, or any other relationship except that of independent contractors. 3.2 While assigned to Facility, Interns will not be considered employees of Facility and Facility shall not be responsible for the payment of any wages, payroll taxes, Social Security, Workers' Compensation insurance, malpractice insurance, or other benefits to or on behalf of such Interns. 4.0 TERMS AND TERMINATION This Agreement shall become effective as of the date first written above ("Effective Date") and shall remain in effect from the Effective Date. A party may terminate this Agreement, with or without cause, upon thirty (30) days' written notice to the other Party. In the event of such termination of the Agreement, an Intern shall have the right to complete the rotation under the conditions and terms of this Agreement, unless Facility requests the withdrawal of that Intern under Section 2.2(f). 5.0 CLAIMS AND DEMANDS BWS DI shall be responsible for all claims, causes of actions, demands, liabilities and expenses arising out of the acts or omission of BWS DI and its Interns while performing services under this Agreement. 4 6.0 NO RIGHTS CONVEYED TO THIRD PARTIES Nothing contained herein is intended to convey or vest any legal right in a third party to enforce terms or conditions of this Agreement. 7.0 ASSIGNMENTS This Agreement shall not be assigned in whole or in part without the prior written consent of BWS DI and Facility. 8.0 CONTROLLING LAW This Agreement shall be governed by the laws of the State of Ohio. All actions commenced to enforce this Agreement shall be filed in a court of appropriate jurisdiction located in Cuyahoga County, Ohio. 9.0. MODIFICATIONS No revision or modification of this Agreement shall become effective or enforceable with respect to a party unless it is in writing and is signed by that party. [The remainder of this page left intentionally blank] 5 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed on their behalf by their duly authorized representatives. Facility By:~ Signature Name:Scott Woolstenhulme Printed Name Title:Assistant Superintendent Date: February 8, 2018 Mailing address: BWS Internship Affiliation Agreement BE WELL SOLUTIONS DIETETIC INTERNSHIP Name~it~- Signature Name: Abigail Saponaro, MS, RDN , LD Printed Name Title: Associate Director Date: February 8, 2018 Mailing address: 30625 Solon Road, Suite C Solon, OH 44139 6